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NPWT over Closed Incisions Decreases Wound Complications following High-Risk TJA

February 19, 2016

Contributors: Herbert John Cooper, MD; Marcel A Bas, MD; Marcel A Bas, MD

Keywords: Complications; Infection

INTRODUCTION: Negative pressure wound therapy (NWPT) applied over a closed incision may improve wound healing through mechanical stabilization, reduction of edema, increased vascular and lymphatic flow, and a reduction of subcutaneous hematoma and seroma. The benefit of prophylactic NPWT to enhance healing of high-risk wounds following hip and knee arthroplasty has not yet been elucidated.

METHODS: This is a retrospective case-control series of NPWT used continuously over a closed incision in high-risk hip and knee arthroplasty patients treated by a single surgeon over a 12-month period. Indications for NPWT included morbid obesity, poorly-controlled diabetes, treatment of periprosthetic joint infection, reoperation in the early postoperative period, or the presence of multiple risk factors for poor wound healing. Wounds were assessed throughout the early postoperative period for the presence of breakdown, dehiscence, necrosis, suture granuloma, or superficial infection. No patients in the study group were lost to follow up before wound healing. A matched cohort of patients from the previous 12 months who did not receive NPWT was used as a historical control group.

RESULTS: NPWT was used in 34 patients in the study period, representing 21.2% of the 160 patients treated surgically in the study period. Therapy was applied for a mean of 6.2 days (range, 3 to 14 days) before being removed. Thirty-two of the 34 wounds (94%) healed without complication, while two (6%) required reoperation for wound necrosis and breakdown. Nineteen of the 34 wounds (56%) in the control group healed without complication, while 8 (24%) required additional local wound care, and 7 (21%) required reoperation. No patients in the NPWT group developed deep infection, compared to two in the study group. There was a significantly lower wound complication rate in the study group (OR 0.08; p < 0.01), and a trend toward a lower rate of reoperation (OR 0.24; p = 0.09).

CONCLUSIONS: Closed incision NPWT demonstrates a significantly lower rate of wound complications in this case control series, and warrants further investigation.

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